title: Inappropriate testing for diarrheal diseases in the hospital.
abstract: To assess the degree to which routine stool cultures, ova and parasite examinations, and Clostridium difficile toxin assays may be inappropriately ordered on hospitalized patients, we conducted a retrospective study to determine the relative yield of these tests on specimens collected from outpatients and inpatients as a function of time after admission. During a 3-year period, only 1 of 191 positive stool cultures and none of the 90 ova and parasite examinations with positive results were from the group of patients who had stool specimens submitted after 3 days of hospitalization. Analysis of laboratory work load for a 1-year period showed that specimens from this patient group contributed nearly 50% of the more than 3000 specimens received each year. In contrast, approximately 25% (range, 17% to 33%) of samples, regardless of admission status, were positive for C difficile toxin. Eliminating routine stool cultures and ova and parasite examinations on hospitalized patients would significantly reduce hospital and patient costs without altering patient care. Nationwide, such a policy might achieve a cost savings of +20 to +30 million per year.
authors.affiliation: Clinical Microbiology Laboratory, Hospital of the University of Pennsylvania, Philadelphia 19104-4283.
authors.forename: D L
authors.initials: DL
authors.lastname: Siegel
authors.forename: P H
authors.initials: PH
authors.lastname: Edelstein
authors.forename: I
authors.initials: I
authors.lastname: Nachamkin
mesh_terms: D000328:Adult; D002167:Campylobacter / Q000302:isolation & purification; D019411:Clinical Laboratory Techniques / Q000706:statistics & numerical data*; D003013:Clostridium / Q000302:isolation & purification; D003625:Data Collection; D003967:Diarrhea / Q000175:diagnosis* / Q000382:microbiology / Q000469:parasitology; D005243:Feces / Q000382:microbiology* / Q000469:parasitology; D006296:Health Services / Q000706:statistics & numerical data*; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006746:Hospital Bed Capacity, 500 and over; D006801:Humans; D007297:Inpatients; D010045:Outpatients; D010270:Parasite Egg Count; D015143:Philadelphia; D012189:Retrospective Studies; D012475:Salmonella / Q000302:isolation & purification; D012760:Shigella / Q000302:isolation & purification